Efficacy of COVID-19 vaccines in patients taking immunosuppressants

Abstract

ObjectivesWe intended to assess the effectiveness of all three US Food and Drug Administration approved COVID-19 vaccines at preventing SARS-CoV-2 infection and COVID-19 hospitalisation in a large cohort of individuals on immunosuppressants for a diverse range of conditions.MethodsWe studied the effectiveness of BNT162b2 (Pfizer–BioNTech), mRNA-1273 (Moderna) and Ad26.COV2.S (Johnson & Johnson–Janssen) vaccines among individuals who take immunosuppressants (including disease-modifying antirheumatic drugs and glucocorticoids) by comparing vaccinated (n=97688) and unvaccinated (n=42094) individuals in the Michigan Medicine healthcare system from 1 January to 7 December 2021, using Cox proportional hazards modelling with time-varying covariates.ResultsAmong vaccinated and unvaccinated individuals, taking immunosuppressants increased the risk of SARS-CoV-2 infection (adjusted HR (aHR)=2.17, 95% CI 1.69 to 2.79 for fully vaccinated and aHR=1.40, 95% CI 1.07 to 1.83 for unvaccinated). Among individuals taking immunosuppressants, we found: (1) vaccination reduced the risk of SARS-CoV-2 infection (aHR=0.55, 95% CI 0.39 to 0.78); (2) the BNT162b2 and mRNA-1273 vaccines were highly effective at reducing the risk of SARS-CoV-2 infection (n=2046, aHR=0.59, 95% CI 0.38 to 0.91 for BNT162b2; n=2064, aHR=0.52, 95% CI 0.33 to 0.82 for mRNA-1273); (3) with a smaller sample size (n=173), Ad26.COV2.S vaccine protection did not reach statistical significance (aHR=0.34, 95% CI 0.09 to 1.30, p=0.17); and (4) receiving a booster dose reduced the risk of SARS-CoV-2 infection (aHR=0.42, 95% CI 0.24 to 0.76).ConclusionsThe mRNA-1273 and BNT162b2 vaccines are effective in individuals who take immunosuppressants. However, individuals who are vaccinated but on immunosuppressants are still at higher risk of SARS-CoV-2 infection and COVID-19 hospitalisation than the broader vaccinated population. Booster doses are effective and crucially important for individuals on immunosuppressants.

COVID-19 vaccine effectiveness against omicron (B.1.1.529) variant infection and hospitalisation in patients taking immunosuppressive medications: a retrospective cohort study

“…Our findings regarding vaccine effectiveness in immunosuppressed patients show a substantial reduction in effectiveness relative to previous studies that looked at the delta (B.1.617.2) variant. 5 , 6 , 7 , 8 , 9 This difference is consistent with a similar reduction in the immunocompetent population, as seen in this study and in previous work. 3 , 4 The higher effectiveness observed for the mRNA-1273 vaccine compared with the BNT162b2 vaccine is also in accordance with previous findings in people who were immunocompetent.…”

“… 3 , 4 Multiple studies in patients who are immunosuppressed have shown mRNA vaccines to be effective against infection and hospitalisation due to the previously dominant delta (B.1.617.2) variant, but there are few data regarding their effectiveness against the omicron variant. 5 , 6 , 7 , 8 , 9 Patients taking immunosuppressive medications have reduced immune responses following vaccination compared with immunocompetent people, but granular data about classes of immunosuppressive medications and dose level are still scarce. 10 , 11 , 12 , 13 , 14 , 15 In addition to vaccine effectiveness, there is little knowledge on how taking immunosuppressive medications affects risk of SARS-CoV-2 infection and hospitalisation due to COVID-19.…”

A Case-Crossover Phenome-wide Association Study (PheWAS) for Understanding Post-COVID-19 Diagnosis Patterns

“…Fully vaccinated patients, whose enrichment patterns resembled the test negatives, were more likely than those unvaccinated to be diagnosed with chronic conditions like hypertension and anxiety in the "post-COVID-19 period." This MM cohort has been extensively studied in the past 26,35,[41][42][43] , but the current study provides the longest follow-up time (over 2 years) to date and includes a "post-COVID-19 period. "…”

Lack of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission from a healthcare worker to a cohort of immunosuppressed patients during the SARS-CoV-2 omicron variant surge, California, 2022

“…Third, these patients were immunocompromised, putting them at higher risk of severe infection and death (as high as 13%–20%) if they were to contract SARS-CoV-2. 4 , 5 …”

“…Third, these patients were immunocompromised, putting them at higher risk of severe infection and death (as high as 13%-20%) if they were to contract SARS-CoV-2. 4,5 We hypothesize many possible reasons why the index case did not transmit to patients or other HCWs. First, the index case was wearing an N95 respirator, which may have provided superior source control compared to surgical masks.…”